Title : Clinical outcomes of intra-medullary hindfoot nailing for traumatic ankle fractures: A six year experience from a UK tertiary centre
Abstract:
Background: Patients with Neck of Femur (NOF) fractures are at high risk of subsequent fragility fractures. Timely initiation of secondary fracture prevention is recommended by the National Osteoporosis Guideline Group (NOGG). At our centre, orthogeriatricians formulate inpatient bone health plans which the orthopaedic team action and communicate to GPs via discharge letter. These plans are often omitted, risking discontinuity of secondary fracture prevention and risk further fractures.
Aims: To assess accuracy of documentation and implementation of orthogeriatric bone health plans in discharge letters in patients following NOF fracture, and evaluate impact of a departmental educational intervention.
Methods: A two-cycle, closed-loop audit was conducted at Arrowe Park Hospital. Discharge letters of NOF fracture admissions were reviewed against locally agreed standards derived from NOGG guidance. After Cycle 1, an educational intervention was delivered to orthopaedic teams comprising a NOGG-aligned bone health toolkit encouraging transfer of the orthogeriatric plan to the discharge letter; re-audit followed. Patients deceased prior to discharge or non-operative management were excluded.
Results: Cycle 1 included 121 patients (mean age 81.5); Cycle 2 included 83 patients (mean age 81.4 years). An orthogeriatric bone health plan was documented in 88.4% of cases in Cycle 1 and 96.4% in Cycle 2. Accurate transfer of this plan to discharge letter improved from 30.6% to 59.0% (χ²=15.2, p<0.001). Appropriate measurement and replacement of calcium and vitamin-D remained high across both cycles (84.3% vs 78.3%). DEXA referral gaps fell (13% to 7%) and antiresorptive treatment prescribing improved (23% to 29%).
Conclusions: Our simple, educational toolkit and structured bone health discharge proformadoubled documentation of bone health plans to GPs at discharge. It also showed an improvement in DEXA referral gaps and antiresorptive prescribing. Embedding structured prompts within ward-level processes can meaningfully strengthen secondary fracture prevention pathways but highlights the ongoing challenges of secondary fracture prevention.
